Facial characteristics and Mizaj

Background

Iranian traditional medicine, originating from Greek medicine, is based on the four elements theory, which defines the origin of life as the composition of the four elements of air, soil, fire, and water [1, 2].According to Iranian traditional medicine, actions and reactions of opposite qualities of these four elements and interaction among“themselves by virtue of their respective powers(qualities)”in varying amounts of these combinations form the unique Mizaj (temperament)of each human being[3].

Each human being has a unique Mizaj based on the combination of the warmness of fire, the coldness of soil, the wetness of water, and the dryness of air [4, 5].The combinations of these elements are generally categorized as Sanguine Mizaj (warm and wet), Choleric(warm and dry), Phlegmatic (cold and wet), Sanguine Mizaj, and Melancholic Mizaj (cold and dry) [4–9].Mizaj is also categorized as innate and acquired.Each individual is born with the innate Mizaj,and the acquired type commonly results from living conditions and lifestyle[4, 5].

According to Iranian traditional medicine, health status is related to the balance of the combination of elements that exist in each individual’s Mizaj, and Mizaj plays a vital role in diagnosing and treating diseases [3].Therefore, the accurate identification of Mizaj of each person is very important.In ancient times, the physicians (which in ancient times were called Hakim)would identify the Mizaj based on their experience while considering various parameters, such as the color of the skin, hair, muscles and fat, touch, complexion, physique,functions and the state of body members.These are the main parameters mentioned by Galen, Rabban Tabri, Razi, Ali Ibn Abbas Majoosi, Jurjani, Ibn Rushd, and Arzani [10].

However, identifying Mizaj is challenging today for traditional medicine physicians, who may diagnose different Mizajs for one individual.Therefore, some attempts have been made to develop standard tools for the accurate diagnosis of Mizaj [11, 12].

Among all parameters used to diagnose Mizaj, facial characteristics play an essential role.According to some studies, facial characteristics alone can validly predict Mizaj [13].

This study aimed to review published articles and books to evaluate the effectiveness of facial characteristics on Mizaj diagnosis.

Methods

Therefore, this review was conducted to evaluate the role of facial characteristics in diagnosing the Mizaj of individuals based on published literature, including the original books of traditional medicine alongside scientific articles published in recent decades.

（33）吾聞渠家其貧，猒多子欲殺，吾難復(fù)人身矣。（《太上說(shuō)玄天大聖真武本傳神呪妙經(jīng)註》卷四，《中華道藏》30/560）

Search strategy

In case of underreporting the data or restriction of access to the article, the article was excluded from the study.

Eligibility criteria

The studies were included if they investigated or used the facial characteristics to diagnose Mizaj.For the traditional medicine books,those mentioning facial characteristics as Mizaj identification parameters were included.If the reviewed traditional medicine book was in Farsi, it should also have authors with authoritative sages of medical history, practical experience in medical work, and successfully published with acceptable eloquence.Gray literature,studies published in languages other than English or Persian, studies that only their abstracts were available and unfinished studies were excluded.Study type was not considered as the eligibility criteria.

Selection process for articles

First, the articles were reviewed and selected based on their title and abstracts, according to the inclusion criteria.Three categories,including “excluded”, “included”, or “probable” were defined.The articles that did not qualify for the study were excluded.The reviewer then examined the full text of the articles categorized as “probable”,and a list was prepared.The list was examined, and the disputes were assigned to the included or excluded category based on the vote of the second or third expert.

Data collection process

強(qiáng)化入海水道工程巡視檢查，既是工程管理規(guī)程規(guī)范的要求，更是由入海水道工程自身特點(diǎn)和功能決定的。入海水道工程的特點(diǎn)主要有：

Study risk of bias assessment

A methodologist investigated all articles based on the international guidelines for reporting, such as consolidated standards of reporting trials, preferred reporting items for systematic reviews, and meta-analyses, strengthening the reporting of observational studies in epidemiology, and the articles with low validity were excluded.

在我國(guó)，書法作品被列為著作權(quán)法保護(hù)對(duì)象，最早可追溯到《大清著作權(quán)律》。我國(guó)現(xiàn)行著作權(quán)法也明確將其列為美術(shù)作品的一種形式予以保護(hù)，這在世界各國(guó)的著作權(quán)立法上是鮮見的。因此，對(duì)書法作品加以著作權(quán)保護(hù)，是極具有中國(guó)特色的立法，尤其對(duì)于毛筆書法而言更是如此。本文嘗試結(jié)合毛筆書法的特性來(lái)探討其著作權(quán)保護(hù)中的一些特殊問題。

Two independent reviewers conducted the eligibility and quality assessment.

稀土礦物主要有氟碳鈰礦、氟碳鈣鈰礦。礦石中的稀土元素以輕稀土為主，主要為鈰組元素的鈰、鑭、釹、鐠等，有少量的重稀土釔。巖石中的主要化學(xué)成分為Ca，Mg，F(xiàn)e，Si，P，CO2(表1);其次為TRE2O3,Al,Ba,Mn,Sr,Ti等;有很少量的Zr,Na,Nb,Cu,Pb,Ga等元素(表2)。礦石中TRE2O3含量0.75%～1.67%，平均1%。

Reporting bias assessment

In March 2022, international credible scholarly databases, including Google Scholar and PubMed, as well as Persian traditional medicine books, were searched.The references of selected articles were also hand searched for finding relevant studies.Islamic medicine software was used to obtain data related to Persian traditional medicine.The keywords used in both English and Persian search include“Mizaj”, “Mizaj identification”, “Mizaj determination”, “facial characteristics”, “nose”, “l(fā)ips”, “chin”, “cheek”,“eyes” and“face”.

The included studies were reviewed for quality and validity, and those studies without quality and validity were excluded.For the final review, all selected articles were carefully studied, and the following data were extracted and entered in the information extraction form:title, type of study, aim,facial characteristic, and results of the study.

1) GB 50151—2010《泡沫滅火系統(tǒng)設(shè)計(jì)規(guī)范》規(guī)定從手動(dòng)或自動(dòng)啟動(dòng)消防泵到泡沫從噴射口噴出時(shí)間不大于5 min，調(diào)研國(guó)內(nèi)油庫(kù)該過(guò)程時(shí)間通常大于5 min甚至大于10 min的情形。研究表明儲(chǔ)罐滅火最佳時(shí)機(jī)是火災(zāi)初期5～10 min。

Result

Table one shows the twenty-two studies and books of traditional medicine that applied facial characters to diagnose Mizaj.These studies included nine published peer review articles in scientific journals and thirteen books of traditional medicine.The facial characteristics used for diagnosing Mizaj include hair color during childhood and adolescence, the hair condition, the face shape, the length of the forehead, size and color of the eyes, the form and size of the nose, the shape of the nostrils, the form of cheek and chin, the size and form of the mouth and lips, the length and circumference of the neck (Table 1) [3, 4, 14–18].

Also, some studies emphasized that the face and nose are the two essential parameters of temperament assessment [22] (Table 2).

The size and form of the nose can also show a wet or dry Mizaj.Narrow nose, beautiful sharp point, and wide nostrils are seen in people with dry Mizaj, and a wide nose tip and narrow nostrils are signs of a wet Mizaj [15, 17].

In addition, curly coarse hair can indicate dry Mizaj, while fine and straight hair can be a sign of wet Mizaj [15].

Table 2 [4,10–17,22–24, 27]shows the facial characteristics used to diagnose different types of Mizaj.In traditional medicine, eye sizeand color can be indicators of a wet or dry Mizaj; people with small eyes have wet Mizaj, and big eyes are among the signs of a dry Mizaj[15].Also, blue eye color is a sign of wet Mizaj, and black eye color indicates dry Mizaj[16].

Discussion

This review was conducted to study the role of facial characteristics in the diagnosis of Mizaj.In traditional medicine, Mizaj diagnosis was made based on different parameters, including skin color,hair muscles and fat, touch, complexion, physique, functions, and facial characteristics [5, 17, 26].

其次，基礎(chǔ)英語(yǔ)習(xí)得的輸入數(shù)量和內(nèi)容不足。據(jù)統(tǒng)計(jì)，中小學(xué)階段每個(gè)學(xué)期，覆蓋一本英語(yǔ)教材，每本涵蓋大約十個(gè)主題單元，每個(gè)單元包含大約一篇閱讀文章和2-4篇2-6個(gè)輪回的對(duì)話，涉及10-25個(gè)新生詞的學(xué)習(xí)。課堂上老師給學(xué)生講授英語(yǔ)語(yǔ)法、句法、生詞和帶讀。課堂下，學(xué)生做識(shí)記型訓(xùn)練，很少有學(xué)生另外花費(fèi)時(shí)間和精力再涉獵額外的英語(yǔ)聽讀輸入材料。

These studies showed that several traditional medicine reference books and many recent scientific articles on diagnosing Mizaj have referred to facial characteristics as determinants of Mizaj in individuals.Some recent attempts to develop standard tools for Mizaj identification have also included facial characters as a major determinant of Mizaj diagnosis.Mojahedi et al.designed a preliminary self-administered Mizaj questionnaire and assessed its reliability and validity in Iran in 2014.This study used a ten-item questionnaire to identify the Mizaj, including two facial characteristics, skin color and hair condition [11].

對(duì)于社會(huì)服務(wù)方面，高校應(yīng)積極為社會(huì)經(jīng)濟(jì)發(fā)展提供智庫(kù)服務(wù)。從社會(huì)經(jīng)濟(jì)發(fā)展的具體需求著手，重點(diǎn)關(guān)注社會(huì)經(jīng)濟(jì)發(fā)展中面臨的重大理論問題和其他實(shí)際問題，進(jìn)行針對(duì)性和前瞻性的研究工作，以主動(dòng)參與到?jīng)Q策咨詢中去。通過(guò)高質(zhì)高效的研究成果，為政府部門的決策和規(guī)劃提供理論支撐，為社會(huì)輿論的發(fā)展提供指導(dǎo)依據(jù)。

Salmannejad et al.conducted a review study to identify head parameters of Mizaj diagnosis.In their study, hair, nose secretion eyes were introduced as three determinants of Mizaj [23].

Naz and Sherani, in their “Determination of human temperament based on the literature of Unani system of medicine” study, identified various determinants of temperament mentioned by different traditional physicians.Galen mentioned “configuration of the head”as one of the fifth parameters.Jurjani mentioned “hair texture, color,and distribution” as considerations.Arzani knew “hair” as a parameter.Ibn-e-Sina mentioned ten determinants, one of which is hair[10].

Based on the finding of this study, some traditional physicians have identified facial characteristics as subsets of main determinants.Razi has pointed to some facial characteristics as minor signs of Mizaj diagnosis[24].

In 2016, Roshandel et al.also developed and standardized a questionnaire to identify the Mizaj of individuals.This questionnaire includes the facial characteristics including the skin color, hair color during adolescence or childhood, facial structure, the size of the forehead, the size of the eyes compared to the face, iris color, color and condition of the sclera, nose size and shape, lips, mouth, and cheeks and their size compared to the face, the shape of the chin, the length of the tongue, and the length of the neck.This questionnaire showed a good level of reliability and validity [12].In their study,Roshandel et al.showed that using only the facial characteristics as a determinant of Mizaj was reliable and consistent with the results of the diagnosis of Mizaj based on the whole set of determinants [13].

Conclusions

This systematic review demonstrated the considerable literature that used facial characters as determinants of Mizaj.Among the twelve facial characteristics identified in the result, some characteristics such as eyes, nose, and chin were selected as the most important parameters for diagnosing Mizaj, respectively.Among all parameters,the color of the iris and the neck length are identified as the most important facial characteristic used for diagnosing Mizaj.After that,the form and size of the nose, face shape, chin, and hair condition were in the next rank in terms of importance in recognizing Mizaj.More experimental studies are needed to determine whether facial characters can be used solely to identify individuals’Mizaj.

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